Rapid opiate detox. Should I do it?

I’m a 34 year old professional with an addiction to opiates. I have been using drugs recreationally since college, but strictly as a weekend kind of thing. About a year ago I started playing around with OxyContin and by now I can’t deny any longer that I am very much an addict.

Although I realize that I likely have some rights to time off for drug treatment through HR at work – I know that my reputation and career trajectory will be very adversely affected should I admit to needing time off for drug rehabilitation. Secrets don’t stay secrets very long in my work environment and I get the feeling that people already have some suspicions about me due to some changes in work performance over the last few months. I have been looking at rapid opiate detox programs – the ones where you are put to sleep while you go through the withdrawals and I would like to know if this is my best option.

I am not terribly afraid of the withdrawals. I know that it will be difficult, but I can handle it. What I can’t handle is needing like a month off to get back on my feet. From what I understand, after 5 or 6 days of rapid opiate detox I’ll be back on my feet and ready to get back to work. Maybe not feeling 100%, but able to work.

Is this accurate? I feel like if I can just get past the withdrawals I’ll never be so stupid as to take another pill in my life, so I don’t think I need any rehab or anything like that. Is rapid opiate detox the best option for someone in my situation?

Dr. David Sack Says...

Before discussing rapid opiate detox it’s important to note that detox is not a treatment by itself. You will need the support of an outpatient treatment program or a mental health provider experienced in treating addictions if you are to be successful. 12-Step support groups can be extremely helpful after going through detox.

There are a number of strategies for detoxing from opiates and their benefits and disadvantages should be evaluated by you with the assistance of a physician who specializes in addiction medicine. This could be an Addiction Psychiatrist, certified by the American Board of Psychiatry and Neurology, a physician board certified by the American Board of Addiction Medicine, or a physician certified by the American Society of Addiction Medicine.

Each person is different and there is no one solution that is appropriate for all clients. Oupatient detoxification from opiates can be achieved with Methadone (through a licensed clinic) or with Buprenorphine (Suboxone, Subutex) in a physician’s office. The safety of either of these methods is extremely well documented and likely exceeds the safety of rapid opioid detoxification under deep sedation or general anesthesia. For outpatient detox to be successful, the individual needs to be highly motivated and generally not abusing other drugs or alcohol. It should be accompanied by addiction counseling. People who are abusing other drugs in addition to OxyContin should probably not be detoxed as outpatients.

There is no convincing data that rapid opioid detox programs result in better long term abstinence, and there is consider data that as many as 40% of those going through rapid detox are having significant withdrawal symptoms at the supposed end of the detox.

If you were to choose to enter residential treatment, you have two choices with respect to work. If you have vacation days accrued, you could apply them to your treatment. There is no guarantee that this will ensure your confidentiality as things tend to leak out at work (usually from someone you’ve told in confidence). As an alternative, you can enter treatment and have the physician provide you with a disability note. In general, work is not entitled to the specifics of your diagnosis or treatment, only the estimated duration of your disability. Another alternative would be to speak with an Employee Assistance Professional or HR about the need to enter treatment, and to have them assist in the process. Which of these would work best in your situation depends on the nature of your position, the attitude toward substance abuse problems in your company, and the financial resources you will need to do this without using sick leave.

I think you are underestimating the problems that led to your becoming addicted and without counseling your chances for success are not good.